MEDICARE: DR. PATRICK C CROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019023286	IL

General Provider Information

NPI Number	:	1538335278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK C CROSS

Provider Business Mailing Address
First Line	:	5915 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1626
Country	:	US
Telephone Number	:	773-685-7121
Fax Number	:	773-685-7143

Provider Business Practice Location Address
First Line	:	5915 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1626
Country	:	US
Telephone Number	:	773-685-7121
Fax Number	:	773-685-7143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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